Woodward Aniek, Fuhr Daniela C, Barry Alexandra S, Balabanova Dina, Sondorp Egbert, Dieleman Marjolein A, Pratley Pierre, Schoenberger Samantha F, McKee Martin, Ilkkursun Zeynep, Acarturk Ceren, Burchert Sebastian, Knaevelsrud Christine, Brown Felicity L, Steen Frederik, Spaaij Julia, Morina Naser, de Graaff Anne M, Sijbrandij Marit, Cuijpers Pim, Bryant Richard, Akhtar Aemal, Roberts Bayard
KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands.
Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands.
Open Res Eur. 2024 May 30;3:14. doi: 10.12688/openreseurope.15293.2. eCollection 2023.
Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems.
A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis.
We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues.
All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.
叙利亚难民心理健康症状负担沉重，在获得心理健康和社会心理支持（MHPSS）方面面临挑战。本研究评估了卫生系统对叙利亚难民MHPSS需求的响应性，比较了欧洲和中东国家，以为加强MHPSS系统提供建议。
采用一种以经改编的世界卫生组织卫生系统框架为指导的混合方法快速评估方法，对八个国家（埃及、德国、约旦、黎巴嫩、荷兰、瑞典、瑞士和土耳其）的卫生系统响应性进行评估。使用了对一手和二手数据的定量和定性分析。数据收集和分析由多名研究人员迭代进行。国别报告用于比较分析和综合。
我们发现卫生系统响应性存在诸多限制：i）合适的心理健康服务提供者和服务太少；ii）与出行相关的障碍阻碍了服务获取，加剧了心理健康工作者分布方面的城乡不平等；iii）由于文化敏感型服务提供者数量不足、专业口译员费用、叙利亚难民痛苦的躯体表现、心理健康意识有限以及与精神疾病相关的污名化，导致及时护理存在文化、语言和知识方面的障碍；iv）心理治疗和前往服务机构的交通费用自付比例很高，降低了可承受性，在中等收入国家尤为如此；v）专科心理健康服务等待时间长；vi）所有国家在难民心理健康需求和MHPSS系统响应性方面都存在信息差距。针对这些问题提出了六项建议。
所有八个东道国都难以向叙利亚难民提供响应性的MHPSS。迫切需要加强心理健康工作人员队伍（在数量、质量、多样性和分布方面），以使叙利亚难民能够获得文化上合适且及时的护理，并改善心理健康状况。增加对心理健康的财政投资和改善卫生信息系统至关重要。
